Monitoring Lung Aeration during Respiratory Support in Preterm Infants at Birth

BACKGROUND: If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (V(T)) to achieve gas exchange. OBJECTIVE: The aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO(2)), V(T), and rate of carbon dioxide elimination (VCO(2)) to assess lung aeration in preterm infants requiring respiratory support immediately after birth. METHOD: A prospective observational study was performed between March and July 2013. Infants born at <37 weeks gestational age who received continuous positive airway pressure (CPAP) or PPV immediately after birth had V(T) delivery and ECO(2) continuously recorded using a sensor attached to the facemask. RESULTS: Fifty-one preterm infants (mean (SD) gestational age 29 (3) weeks and birth weight 1425 (592 g)) receiving respiratory support in the delivery room were included. Infants in the CPAP group (n = 31) had higher ECO(2) values during the first 10 min after birth compared to infants receiving PPV (n = 20) (ranging between 18–30 vs. 13–18 mmHg, p<0.05, respectively). At 10 min no significant difference in ECO(2) values was observed. V(T) was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2–6.6 vs. and 7.2–11.3 mL/kg (p<0.05), respectively. CONCLUSIONS: Immediately after birth, spontaneously breathing preterm infants supported via CPAP achieved better lung aeration compared to infants requiring PPV. PPV guided by V(T) and ECO(2) potentially optimize lung aeration without excessive V(T) administered.